Prognosis. 29 



To give a sonud prognosis the practitioner must have a thor- 

 ough knowledge of pathology, he must have acute powers of ob- 

 servation, and he must be quick to appreciate every point that 

 makes for or against the patient in the particular case. 



The causes of the trouble must be carefully considered. Are 

 they transient or permanent ? Are they removable or irremova- 

 ble ? x\re they external or internal ? As a rule an internal 

 cause is the more redoubtable. Some lesions are necessarily fatal, 

 as a needle penetrating the heart or an attack of rabies or milk 

 sickness. Is the cause an enzootic one? If so can the patient be 

 removed from the locality ? Is it a fatigue fever or an infectious 

 one? Is it a simple inflammation or an infecting one? The lat- 

 ter are usually much more grave. In case of contagious disease, 

 can its propogation be prevented? Is it of a fatal or non-fatal 

 type? Is it situated in a tis.sue favorable to a fatal exten.sion, 

 (anthrax in lung) or in one unfavorable (anthrax in the tip of 

 the tail) ? Disease in a single vital organ like the heart is neces- 

 arily much more grave than in one of a symmetrical pair (kid- 

 neys, lungs) one of which can carry on the functions. The reg- 

 ular progress of the disease and especially an uninterrupted im- 

 provement, following on a critical perspiration or urination, is a 

 good prognostic sign, whereas unevenness of temperature, pul.se 

 and respiration, with temporary aggravations of the general symp- 

 toms, should demand a less hopeful prognosis. The persistence 

 of the malady is also an unfavorable indication. A relapse after 

 partial recovery is a serious indication unless due to some obvious 

 and easily removable cause, and unless the former convalescent 

 condition is .speedily restored on its removal. A complication is 

 a serious indication whether it consists in an embolism, or new 

 centre of the same disease, or the supervention of a second dis- 

 ease upon the first. The .system has ju.st so much more to con- 

 tend with and the very .supervention of the second focus or malady 

 argues a special su.sceptibility, debility, or lessened power of re- 

 sistance. 



The prompt success or entire insucce.ss of treatment proves val- 

 uable. 



The preservation of appetite, the slow, uniform descent of the 

 temperature, and the improvement of pulse and breathing are 

 among the most valuable indications. 



